FRANKFORT, Ky. — The Trump administration has again approved new rules for some of Kentucky’s Medicaid population, requiring them to either get a job, volunteer in the community or go to school to keep their government-funded health coverage.

The Kentucky Cabinet for Health and Family Services announced the approval on Tuesday, nearly five months after a federal judge blocked the state’s first attempt. State officials say the new rules can begin as soon as April 1 and will be phased in regionally over several months. They will require adults ages 19 to 64, with some exceptions, to complete at least 80 hours per month of “community engagement” to keep their health benefits. That includes getting a job, looking for a job, going to school, volunteering for community service or taking a job training course.

Kentucky is one of 37 states that has expanded its government-funded health insurance program to include low-income adults with no children and no disabilities. More than 400,000 people signed up for the program, dramatically dropping the state’s uninsured rate and propping up some rural hospitals who depend on the revenue.

But Republican Gov. Matt Bevin has criticized the program, saying it is too expensive and does not make Kentucky’s citizens healthier as the state is still behind most of the country in some key health indicators.

Bevin proposed requiring some Medicaid recipients to take action to keep their benefits. In January, Kentucky became the first state ever to win federal approval for such a plan. But in June, a federal judge blocked it, ruling the government did not adequately consider how the plan would impact people who receive coverage.

The judge’s ruling re-started the application process, which was completed Tuesday. It’s possible the program could wind up in court again.

The new rules will be in place for five years. The Bevin administration predicted the requirements would save taxpayers more than $2 billion during that time, including $300 million in state dollars. State officials estimated at least 95,000 people would lose coverage, either through not complying with the rules or by getting jobs and earning enough money to make them ineligible for the benefits.

Arkansas was the first state to implement work requirements for Medicaid. Last week, the state announced more than 12,000 people had lost coverage in the past three months for not complying with the new rules. The Arkansas Department of Human Services said another 6,000 people are at risk of losing coverage by December if they do not comply.

Bevin, in a statement posted to his official Twitter account, said the approval means the state can “continue to provide services for traditional Medicaid beneficiaries, while also offering a path toward improved health outcomes for all recipients.” Kentucky Cabinet for Health and Family Services Secretary Adam Meier said in a news release the new rules will help people have “success through long-term independence.”

Kentucky Voices for Health, an advocacy group, said they were “deeply disappointed” with the decision. Executive Director Emily Beauregard said during the public comment process, thousands of Kentuckians said access to health care was vital to their ability to be productive and successful.

“Reapproving a waiver that makes hardworking Kentuckians jump through hoops to keep their coverage will no doubt have the opposite effect,” she said.

The new rules do not apply to pregnant women, full-time students, former foster care youth, survivors of domestic violence, and primary caregivers of children and the elderly, among other exemptions. It would also exempt the “medically frail,” a broad term that includes people suffering from alcohol and drug addiction.

Some benefits, including dental and vision, are no longer included. But people can earn those benefits back through a rewards program.

Left:
AURORA, CO - MARCH 27: Jonathan Orejel holds his son Jonathan Saul Orejel, six-weeks-old, while at a community health center on March 27, 2012 in Aurora, Colorado. The center, called the Metro Community Provider Network, has received some 6,000 more Medicaid eligable patients since the healthcare reform law was passed in 2010. Expansion of such clinics nationwide is considered key to serving the millions more patients set to be be covered by Medicaid if the healthcare reform passes the current challenge in the Supreme Court. Preventative health services and treatments at community health centers are also designed to reduce emergency room expenditures, which are up to 10 times more costly. (Photo by John Moore/Getty Images)